Take+Control+of+Your+Diabetes

 By Ellie Rest contact at RestEz4@hotmail.com ||  ||
 * || =Controlling of Your Type 2 Diabetes =

Approximately 20.8 million people in the United States have diabetes. Adults diagnosed with diabetes have type 2 diabetes in 90 to 95% of cases. Diabetes affects people of all ages, races and ethnicities with African American, Hispanic/Latino Americans, American Indians and Asian Americans at a higher risk of developing the disease and its complications. For some people, diabetes may be hereditary or gestational; for others it may be associated with diet, obesity, physical inactivity, impaired glucose metabolism, older age, or race and ethnicty.

When a person is first diagnosed with diabetes, one of the most difficult things to learn is how to keep blood glucose levels stable so the level is not too high, hyperglycemia, or too low, hypoglycemia and so that further complications of the disease do not occur. //Controlling your Blood Glucose Levels// is an adventure and competition learning game designed to teach patients how to control their blood glucose levels so they can live healthier and happier lives. The game will provide newly diagnosed people with type 2 diabetes with a simulation environment which reflects real-world decisions and consequences. The decisions players make regarding diet, exercise, work, sleep and general activities, will affect their player's overall score and blood glucose level. The learner will need to continue to keep their blood glucose level consistent and remain in good health throughout the game to achieve a high score. Each players score will be posted with their log-in name online so they can compete with others or with their own personal score. = = =Instructional Objectives =

 
 The game's instructional objectives are to get learners to understand how activities, food choices and intake, and medication are balanced to maintain a consistent blood glucose level and keep a person with type 2 diabetes feeling healthy. The decisions that are made around each of these components affects how a person feels and how much diabetes impacts his or her daily lifestyle. The learner should be able to determine basic guidelines around eating well and maintaining a balanced blood glucose level after playing the game. They should also come away with possible solutions on how to handle blood glucose levels that exceed or drop below acceptable levels, tips for dining out, tips for exercising and eating well, as well as other diabetes resources.

Learners
   The targeted audience for // Controlling Your Type 2 Diabetes // is newly diagnosed adults with type 2 diabetes. Depending on the person's experience and background, they may have some knowledge of what type 2 diabetes is and how it affects the body, but most likely will not know how much it can affect the way they live their lives and how they will need to change their lifestyle choices if they want to continue to feel healthy. Since diabetes can be unpredictable at times, it is unlikely that learners will have a comprehensive understanding of just what this disease means to their decision-making process on a daily basis.

As a secondary use, the game could also be used by medical personnel or family and friends of people with type 2 diabetes get a better understanding of their patients or family or friend's disease state. The game could also be distributed with blood glucose meters as a tool to encourage the use of the meters. Another use for the game could be for people with gestational diabetes or for people who are at risk of getting diabetes. For people at risk of developing type 2 diabetes, the game could serve to teach them about how to eat well and exercise and take precautions to preventing the disease and its complications.

**Context of Use **
 //Controlling Your Type 2 Diabetes// could be played on any computer or laptop in a home, office or even at a diabetes education center, at health care professionals’ offices, at hospitals, medical teaching schools or at companies that treat diabetes. The game is designed to be played more then once. The learner can pick between four different players of different ages, genders, races and ethnicities to see how type 2 diabetes affects people differently. Learners may play the same player again and again, making different decisions to see how their score and the outcomes change. They may also choose to play using a different player.

No matter what player is chosen all players will be thrown into the same world or adventure, in which they must overcome daily obstacles and make decisions for that player in each scenario to see what the consequences are on the player's blood glucose level, health and overall score. The game will continue through a person's average week and include different scenarios and interactions that a person with type 2 diabetes may encounter. Players will need to have access to the internet to play the game and have Flash plug-ins and Quick Time. The game is designed to be played individually, but there is a social element to it as well. Since players' scores are posted online when they complete the game, there is an element of competition to beat other players' score as well as their own. While the game is played, players will have access to various diabetes resources to learn more about their disease and how to control it. The game will require the user to log-in and either continues the game where they left off or start a new game so it could take 10 minutes or 2 hours to complete the entire game. The platform would most likely be use Flash and a combination of technical elements including Photoshop, Dreamweaver, Flash backend database, Illustrator and html. These platforms help provide life-like simulations that are real-world and that adult players can relate to. Players can experiment with variables and decisions and this would change the outcomes of their score or health. =Scope = //Controlling Your Type 2 Diabetes// would take players through a somewhat typical week for a person with type 2 diabetes. This week would include some everyday activities such as eating meals, sleeping and working. The game may also include different scenarios that may challenge the player's knowledge. The content will include making decisions about what types and quantities of food to eat, what activities and exercises to participate in, entertainment options, working and how much sleep to allow for each player. All of these elements will be related to blood glucose level, health and score. The game will incorporate warnings if blood glucose levels exceed a certain number or fall below the specified range to help newly diagnosed patients monitor their blood glucose levels.

The game will include special objects in settings that can be rolled-over with a mouse to get tips about diabetes education and acquire information that will add to their decision-making and strategies about balancing blood glucose levels and health. These elements will add complexity to the game to challenge learners to explore the screen for additional information and knowledge. The players will always have access to a "Diabetes Education Book." The book will open to the most relevant page per the game screen, but players can use the entire book at any point during the game to assist in their decision-making process. The Diabetes Education Book will include carbohydrate and fat counting information, techniques to managing diabetes, guides to eating out and tips for balancing blood glucose with meals and exercise. All players’ scores will be posted online so it is a world-wide competition that can continue on and on and be both individually played, but socially competitive. <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> =<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">Object of the Game = <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> The object of the game is to get through the entire game keeping your player’s blood glucose levels stable within a specific range on the blood glucose meter and in good health on the health meter so the overall score is high. If levels get too high or too low as marked on the meter, players will have options of how to fix the situation, but these levels will reflect in their overall game score. If a player chooses to ignore warnings or makes wrong decisions, their scores will decrease and the player may not make it to the end of the game. Players can compete with external players to see who can get a higher score or compete with their own score using the same or different characters. =<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">Competing Products = My research on serious online games revealed that there were many games on diabetes, but most targeted children. There was plenty of information about diabetes on the American Diabetes Association web site as well as other resources, but players have to search out the type of information they are looking for and data is not integrated into the games. Most games focused on children and seemed to ignore the idea that adults may like to learn through games as well. While there is a wealth of knowledge on diabetes, eating right and controlling blood glucose, there is a gap in communicating this information to newly diagnosed adults with type 2 diabetes who may feel overwhelmed by all the articles, web sites, and guides that have advice, studies and information about their disease. Here is what my research found:

[|Glucoboy] – This game is about blood glucose management. The game is a competition game where users compete for better scores with other users they do not know. The player logs in and creates a name. The goal of the game is to increase points by testing blood glucose with a meter. The score gets posted and others can see the score online and try to beat it.

[|Build A Healthy Kid] – The player picks a boy or girl to represent them, and then picks three activities from a list and three foods from another list. The game computes a score, “Healthy Kid” or “Unhealthy Kid.” This game is very simplistic and short and doesn’t offer any information or feedback to help the player learn how the food and activity correlate or connect to diabetes or being a healthy kid.

[|Build a Healthy Plate] - The player's goal is to create a healthy plate. The game is one screen with multiple pieces of food floating though space. The player chooses four foods and wins if they meet the healthy requirements, having a protein, starch, vegetable and fruit. This game is very simplistic and does not integrate feedback about diabetes or how to live a healthy life. The game's content and elements did not correspond or relate either.

[|Food Fight] ** – ** The player chooses a player from a list of characters and then joins a cafeteria setting. The player grabs food from a conveyor belt and throws it at other players to get points. This is supposedly correlated to blood glucose, but it is a far stretch. If the player gets hit with food from other characters in the game, his or her blood glucose goes up. If the player hits another player with food, his or her blood glucose goes down. The game proceeds through levels with the same plot and the score continues to accumulate.

[|Escape from Diab] – This game is a video game created for children between the ages of 10 and 12 with type 2 diabetes. The players live in a town called Diab that is ruled by an evil king, Etes. The players must overcome the king who has flooded the land with junk food. This is more of a fantasy game where children learn to eat and live healthier lives.

[|Nanosworm] – This game has not been officially released either. It was described as a video game for kids on how to live healthy lifestyles .The game is a race game where kids have to race a diabetic epidemic that is caused by unhealthy living.

[|G4H 2008 Serious Games for Improving Diabetes Self-Management] – This game is being created now, but no information was available on how the game works or is played.

All the games reviewed were targeted for children, not adults and most were simplistic in nature. My game will be different because it targeted primarily for adults and the world adults live in. It is an adventure competition game based on real-world situations and will look very life-like. Blood glucose levels and health will be included in the game, but the scenarios, decisions and resources will make the game more complex. Diabetes is more complex than just grabbing a meal in a cafeteria, or picking an activity and food. This game will attempt to integrate some of the complexities of diabetes and include situations based on things adults may face and not know how to handle being newly-diagnosed type 2 diabetics. Players must continue to play throughout the entire game to understand what an average week would really be like for someone with type 2 diabetes. =<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">Design Details = <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> //Universal Elements// The game will look very life-like and be colorful and animated. The player will log-in with their name or a pseudonym if desired that will be posted once the game in over. The player will be represented by an animated character that the player will choose in the beginning of the game. The characters will be realistic to make the game as real-world as possible, but will be animated to add some fun to the look and feel of the game. Once a player chooses a character to represent them, this will be the player he or she is making decisions for throughout the game. The player will have a birds-eye view in the game of their player as they progress through the game. All players will be thrown into the same world and face the same scenarios, interactions and daily activities. Decisions may make something in the game change for players so there may be differences in the game depending on the choices made by the player. The screens will represent real-life situations in the daily life of a person with type 2 diabetes. Various settings may contain different objects that when rolled-over with the mouse gives players extra tips and knowledge. There will be several universal elements that will always appear on the screen - the blood glucose level meter, the health meter, and the players overall score and the Diabetes Education Book. The book will open to different pages that are relevant to the situation when click on, but the player will be able to use the entire book throughout the game. <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> //Specific Elements// The mathematical and logical relationship for the variables will be different for each character with type 2 diabetes since the disease affects people of different ages, genders, races and ethnicities differently. The blood glucose level, health score and overall score will be correlated depending on the decisions made based on a mathematical formula built into the backend of the game. The player is given a range of what the target blood glucose is before and after eating and this is the goal. The health meter also shows good health and bad health. Warnings will be given if the blood glucose exceeds or drops below the target range to make newly diagnosed patients aware that they are no longer in the range. This will help them monitor the progress of the meter. They may be able to score additional points and re-balance their blood glucose levels by using elements from the game that are rolled-over to gain points and either increase or decrease the blood glucose level.

If blood glucose goes way up or down, the health meter will go way down showing poor health and the player's score will decrease. If the blood glucose levels are stable, the health meter will show good health and the player's score will increase. The blood glucose levels will be mathematically tied to the choices made. Input variables will include what type of food a player eats, portion sizes ingested, amount and type of exercise and activity, hours of sleep, stress levels and daily interactions and lifestyle choices. These variables will calculate output variables including blood glucose levels, health and overall score. <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;">  <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> For example, if a person orders a meal with many grams of carbohydrates and sugar, this will be reflected with an increase in blood glucose level and a decrease in score. If a player chooses to exercise, blood glucose levels will decrease and the players score will increase. If a player decides to go out drinking or to a party, the blood glucose levels will increase and scores may decreases. Each of these variables will increase or decrease the level and the player will need to either eat to bring the levels back up or exercise or relax to bring the levels down. Players will be interacting in the game with various people including clients, waiters, friends and family. Their decisions will factor into the output variables. In addition to the //Diabetes Education Book//, objects on the screen will be available when rolled over to increase player's strategy and motivation to achieve a high score and balance glucose levels. These objects may or may not be obvious and may require the user to search the screen to gain points and either balance their blood glucose level or increase their health.

// Sample of game design // The game will start with a screen that provides some general facts about type 2 diabetes. It will describe how many people are affected by the disease, what causes it, when most people are diagnosed with the disease. The introduction will explain that in many cases, type 2 diabetes can be controlled if people make the right decisions and choices in lifestyle. It will explain the goal and instructional objectives of the game. <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> The next screen will explain how to play Controlling Your Type 2 Diabetes and the object of the game. The players will get to choose from four characters of different ages, genders, races and ethnicities. This character will represent the player throughout the game. The learner will be informed about the special objects on in the game like objects that can be rolled-over for additional hints and clues to assist in decision-making and getting through the game. Players will be told how to use the Diabetes Education Book, what the score means, and how to read the Blood Glucose Level Meter and Health Meter.

Then learners will begin the game once they click on a character of their choice. They will be given a brief profile on their player, such as age, weight, general health, when they were diagnosed and a background of their life. The player will be thrown into the game which starts at the beginning of a work week. Learners will start with a normal blood glucose level and in good health with a score of 100. They must move through the game with a stable blood glucose. The decisions they make will effect their day and the days to follow.

Here is an example of what an average screen may look like in the game. In the sample screen below, the score appears in the upper right corner and the blood glucose meter and health meter appear in the upper left corner. The Diabetes Education Book will always be available at the bottom of the screen and the player can click on it to get information about that scene or refer to any page in the book during the game. The player can also use their mouse to roll-over items and get hints and tips throughout the game. Questions will be asked by a characters in the game such as a waiter, family member or colleague and the player will make a decision by clicking on an item in the game. This will influence their score, blood glucose level and health.

When the user enters the setting, the initial blood glucose level and health will be at an acceptable range. This will change based on their decisions and the mathematical equations on the backend of the game. The Diabetes Education Book will have pages that will apply to each scene and will open to the appropriate page when clicked on, like these sample pages for a breakfast scene and tips for eating out below:





//Technical Elements and File Formats// The game will be designed in Flash with backend capabilities that allow mathematical equations to calculate input variables and how they effect the output variables. Different voices will be used and recorded using Audacity to record and edit the narration. Graphics can be created using Flash, as well as using clips from Microsoft, iStock Photos and manipulating and building screens and pictures in Photoshop, InDesign and Illustrator. Graphics will be used a gif. or jpg. files. Some screens may be created in Dreamweaver or InDesign, but the user will need online access and Flash Plug-Ins and QuickTime to run the game. <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> =<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">Motivational Issues = <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> The game will be motivational to learners since it is an adventure and competition game. Most players will be newly diagnosed people with type 2 diabetes who are curious, interested and need to know about what it means to live with type 2 diabetes for the rest of their lives and to control their diabetes and blood glucose levels. They have a need to know how to make their lives healthier so it has immediate relevance to their lives. This applies to the relevance described in the ARCS model in that learners can apply the knowledge leaned immediately and accomplish the goal of having healthier lives (Keller and Suzuki, p. 404).

Malone and Lepper theorize that motivation is increased when learners can choose the task to undertake and which problems to solve (p.239). In this game, there is a sense of control since learners can choose their player and make their own decisions throughout the game. These decisions will have effects on their health, blood glucose levels and score which creates a challenge to make the right decisions. As the game progresses, learners are given hints and resources to assist them so they will not get too frustrated by the challenge presented. This applies to Malone and Lepper’s theory of motivation in that learners must be provided “performance feedback concerning goal attainment that will engage and enhance the self-esteem of individual” (p. 231). There will an element of competition in the game in that players' scores will be posted online for others to see. This social element creates a sense of competition against others and one's self to achieve higher scores and show better control of blood glucose. This may motivate some players to play the game multiple times making different decisions that will affect their score.

There is a clearly defined goal, to keep blood glucose stable, be in good health and finish the game with a high score, which increases motivation according to Malone and Lepper (p.224). Since the players have the option to replay the game, they can increase their skills without serious consequences and learn from their mistakes.

This game also provides immediate performance feedback. According to Malone and Lepper (p. 232), “both learning the activity and sustained motivation depend on performance feedback.” Since learners glucose levels, health meter and score will automatically be reflected after they make a decision, they are provided with immediate feedback on how their decision affected their score and health and what was wise or unwise in the case of their disease state.

In the ARCS model, Keller and Suzuki suggest that attention can be sustained if new unexpected events are introduced that create a deeper level of interest for learners (p. 404). Since players choose their character different audio and make their own decisions, the situation may look different. This will keep learners attention since the scenarios will constantly be changing depending on the decisions made. =<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">Design Process = <span style="font-size: 11pt; font-family: Arial,Helvetica,sans-serif;"> Since I work for a company that makes diabetes drugs, I know how important it is for people to understand what people with diabetes deal with on a daily basis regarding balancing blood glucose, diet, exercise and health. During the Board Game assignment in EdTech 670, my first topic idea was to create a game around controlling blood glucose levels. After considering how to execute such a game, I thought a serious e-game would be a more appropriate venue that could simulate real situations and decision points and use mathematical formulas to calculate variables and make the game more complex. In my initial design of the e-game, I included the idea that learners would choose charcaters in the game and various scenarios so that the game could be more practical and apply to multiple audiences. The idea to use the game for medical staff and family members also occurred to me as I was thinking about the audience since it is so important to be able to understand what someone is going through and be supportive of their lifestyle and to teach pharmaceutical employees, medical personnel and patient support staff how to help their patients with diabetes. My first draft of the e-game had players choosing between a type 1 and type 2 character with diabetes. I rejected this idea since people with type 1 diabetes are usually diagnosed as children and type 2 diabetes is more likely to onset in early adolescence or adulthood. The two types of diabetes are different in how you and I felt their would be too many variables to include in a game for a person with type 1 diabetes such as insulin pumps, daily shots, and constant monitoring of blood sugar. Since the e-game is for recently diagnosed people with type 2 diabetes, the variables are more simplified to diet, exercise and in some cases, medication.

My first draft was a scenario-based game where players picked a scenario or situation (i.e. a baseball game, a party, going to the beach, eating out). The learner played through the scenario making decisions which would affect his or her character's blood glucose level. The purpose of this format was to assist players in learning by allowing them to choose a setting that was relevant to them. After discussing my ideas with Professor Dodge, I decided to change the format of the game to make it more of an adventure, competition game where players where put into a world or adventure that they must get through to complete the game. The decisions the learners make affect their character's blood glucose level and health still, but the players also receive a score based on their choices and must continue through the game until they reach the end. This is more realistic of what a person with type 2 diabetes would have to endure on a weekly basis rather than just picking a scenario that may occur occasionally in their life. My draft always included the idea that diabetes resources would be available to players, but in the newer version, the way these resources were presented changed. By using an adventure game format, these diabetes resources could be incorporated in a fun way as objects on the screen that players must identify and roll-over with their mouse to gather more information on diabetes. I gathered background information from my own personal knowledge on diabetes, by speaking with physicians and diabetes educators that I work with and from friends and family who have type 2 diabetes. I also conducted online research and went to the library to gather resources that would be helpful to include in the game. From this research, I was able to determine a shortened version of guidelines for eating well when dining out, techniques to control blood glucose and ways of lowering or increasing blood glucose. I found a book on carbohydrate and fat counting and was able to incorporate information from this book into situations where the player may be choosing what to eat.

To determine if the game would be helpful to people with type 2 diabetes, I explained the concept to many friends, family members and colleagues. I also send the draft design document to people with type 2 diabetes and classmates and asked for feedback on the game concept and actual document. From this research, I received positive feedback that it would be nice to have a fun way to learn about controlling blood glucose. Many people with type 2 diabetes were simply sent home with a packet of information to read by their physicians or went online and were overwhelmed by the various types of information about type 2 diabetes and the multiple ways that it can be controlled in many cases. These respondents thought a game that reduced the information to a simple format would have been great. They also liked the idea of playing the game and discussing topics from it with their physicians after playing so they could better understand their disease.

The feedback from my classmates was very important and helpful to adding elements that were missing from the game and that I had overlooked. I found it interesting that several of the people who reviewed that game had family with type 2 diabetes and were drawn to the game for this game. One comment that was easy to fix was a spelling error and another example suggested adding links to the competing games which was easy to do. Other comments I received suggested that the game could also be a helpful for people with gestational diabetes or who were at risk of diabetes so they could learn about the disease and prevent it or prolong the onset of type 2 diabetes. Another use could be to give the game out with the blood glucose meter as a way to motivate and/or teach people to use the meter. Other comments that I will incorporate into the game to make it more appealing are the idea of alerts if the blood glucose levels exceeded or got too low, progress checks and emphasizing the importance of the items in the game (objects that are rolled over) that would increase the randomness of the game and make it more challenging to players.

=<span style="font-size: 14pt; color: rgb(134,24,24); font-family: Arial,Helvetica,sans-serif;">References = Books & Journals •  Burani, Johanna, M.S., R.D., C.D.E, and Linda Rao, M Ed. 2002. Good Carbs and Bad •  Carbs. Marlowe & Company. New York, New York. •  Csikszentmilalyi, M. (1990). Flow: The Psychology of Optimal Experience. “// The Conditions of Flow. //” HarperCollins: p.71-93. •  Holzmeister, Lea Ann, RD, CDE. 2005. The Diabetes Carbohydrate and Fat Gram Guide, 3rd Edition. American Diabetes Association, Inc, Canada. •  Jonassen, D. (1988). Instructional Designs for Microcomputer Courseware. // “Use of the ARCS Motivation Model in Courseware Design //” by Keller, John and Katsuaki Suzuki. Lawrence Erlbaum Associates, Inc.: p.401-434. Electronic
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